OPHTE# V21-6-0 Harnett County Department of Public Health 24990
PERMIT # '30CQP Apgfration Permit� t�C-$, 7 - It 1(0
New Installation epti�
c Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Docs 2aa ' 113 I 1 ec El-wcxj Dc,.
Name: (owner) VA .W C otx56r LA, r,,,, SUBDIVISION Qc 44c A -k-- LOT #/S-�,
System Installer. a.Sto---� V50 r L�X cnq Registration #
Basement with plumbing: ❑ Garage Er Nu� of Bedrooms
Type of Water Supply: ❑ Community L?Public ❑ Well Distance from well ✓,A feet
System Type: �6 % 1UA,Y,E- iZ,c) S..< . - —r—�_ —Types V and VI Systems expire in 5 years.
(In accordance with Table Y a) (— Ow usner h t contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961. j
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage ' osal system on the abovica ' d property.
Elal
Type of system: Conventional Other �Septic Tank: TC gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ( of each ditch 00 feet ditches feet ditches RQ inches
french Drain Required: Linear feet
Authorized State Agent Date
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